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Background <p>The triglyceride-glucose index (TyG) and the atherogenic index of plasma (AIP) are well-established indicators of insulin resistance and lipid metabolism, respectively, and both are associated with stroke risk. However, the joint impact of TyG and AIP—expressed as their product (TyG-AIP)—and its longitudinal trajectory on stroke risk have not been investigated. Moreover, it remains unclear whether TyG-AIP interacts synergistically with hypertension to improve stroke risk prediction.</p> Methods <p>This prospective cohort study included 5786 participants, categorized into dysglycemia (PDM, n = 3,490) and normoglycemia (NDM, n = 2,296) groups. TyG-AIP was calculated as the product of TyG and AIP. K-means clustering was applied to identify distinct patterns of TyG-AIP change between the two measurement points. Multivariable Cox proportional hazards models, restricted cubic splines, and receiver operating characteristic (ROC) analyses evaluated associations and predictive performance.</p> Results <p>Over 8&#xa0;years of follow-up, 460 incident stroke cases occurred. Higher TyG-AIP levels were independently associated with an increased risk of stroke (per SD increase: HR = 1.35, 95% CI 1.21–1.51; <i>P</i> &lt; 0.001), with a stronger effect among those with dysglycemia (HR = 1.54, 95% CI 1.21–1.95; <i>P</i> &lt; 0.001). A nonlinear association was observed (<i>P</i> for nonlinearity = 0.002). TyG-AIP synergistically interacted with hypertension, and individuals with both high TyG-AIP and hypertension had the greatest risk (HR = 2.89, 95% CI 2.22–3.76). The “high-and-declining” TyG-AIP trajectory conferred the highest stroke risk in the PDM group (HR = 2.26, 95% CI 1.62–3.15; <i>P</i> &lt; 0.001). ROC analysis showed that a model combining TyG-AIP with hypertension (AUC = 0.643) provided improved discrimination compared to hypertension alone (AUC = 0.571).</p> Conclusions <p>TyG-AIP is associated with increased stroke risk, particularly in dysglycemic individuals, and exhibits joint effects with hypertension. The integration of TyG-AIP assessment with hypertension status enhances risk stratification, supporting comprehensive management of both metabolic and hemodynamic factors in stroke prevention.</p> Graphical abstract <p></p>

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The joint association of the combined triglyceride-glucose index and atherogenic index of plasma with hypertension on stroke risk across different glycemic status: a prospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年3月26日

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  • Xuelun Zou,
  • Chang Zhou,
  • Ruining Zhou,
  • Ting Zhu,
  • Jieyu Zhao,
  • Wenxiang Qing,
  • Jiawei Xie,
  • Rili Yu,
  • Fan Zhang,
  • Jin Li

摘要

Background

The triglyceride-glucose index (TyG) and the atherogenic index of plasma (AIP) are well-established indicators of insulin resistance and lipid metabolism, respectively, and both are associated with stroke risk. However, the joint impact of TyG and AIP—expressed as their product (TyG-AIP)—and its longitudinal trajectory on stroke risk have not been investigated. Moreover, it remains unclear whether TyG-AIP interacts synergistically with hypertension to improve stroke risk prediction.

Methods

This prospective cohort study included 5786 participants, categorized into dysglycemia (PDM, n = 3,490) and normoglycemia (NDM, n = 2,296) groups. TyG-AIP was calculated as the product of TyG and AIP. K-means clustering was applied to identify distinct patterns of TyG-AIP change between the two measurement points. Multivariable Cox proportional hazards models, restricted cubic splines, and receiver operating characteristic (ROC) analyses evaluated associations and predictive performance.

Results

Over 8 years of follow-up, 460 incident stroke cases occurred. Higher TyG-AIP levels were independently associated with an increased risk of stroke (per SD increase: HR = 1.35, 95% CI 1.21–1.51; P < 0.001), with a stronger effect among those with dysglycemia (HR = 1.54, 95% CI 1.21–1.95; P < 0.001). A nonlinear association was observed (P for nonlinearity = 0.002). TyG-AIP synergistically interacted with hypertension, and individuals with both high TyG-AIP and hypertension had the greatest risk (HR = 2.89, 95% CI 2.22–3.76). The “high-and-declining” TyG-AIP trajectory conferred the highest stroke risk in the PDM group (HR = 2.26, 95% CI 1.62–3.15; P < 0.001). ROC analysis showed that a model combining TyG-AIP with hypertension (AUC = 0.643) provided improved discrimination compared to hypertension alone (AUC = 0.571).

Conclusions

TyG-AIP is associated with increased stroke risk, particularly in dysglycemic individuals, and exhibits joint effects with hypertension. The integration of TyG-AIP assessment with hypertension status enhances risk stratification, supporting comprehensive management of both metabolic and hemodynamic factors in stroke prevention.

Graphical abstract